Obstetrical outcomes of embryo reduction and fetal reduction compared to non-reduced twin pregnancies
- 138 Downloads
To prevent perinatal morbidity and mortality of high-order multiple pregnancy (HOMP), multifetal pregnancy reduction (MPR) is offered to some patients. In this study, we investigated whether twin pregnancies derived from MPRs carry a higher adverse obstetrical outcome compared to non-reduced control group of twins.
We retrospectively analyzed the data from HOMPs on which transvaginal ER (n = 153) at a mean gestational age of 7.6 weeks or transabdominal FR (n = 59) at a mean gestational age of 12.4 weeks was performed between December 2006 and January 2018. The risk of each procedure was evaluated by comparing obstetrical outcome with that of a control population of 157 non-reduced twins conceived by infertility treatment.
The mean gestational ages at delivery were 35.2 weeks in the ER group, 35.7 weeks in the FR group, and 34.1 weeks in the control group (P = NS). Compared with those in the control group, the ER group had higher miscarriage (1.3% vs. 6.5%; P = 0.047; OR 0.21; 95% CI 0.45–0.898) and higher overall fetal loss (3.8% vs. 14.4%; P = 0.003; OR 0.24; 95% CI 0.09–0.60) rates. Differently compared with those in the control group, the FR group had no statistical difference in miscarriage (2.5% vs. 1.7%; P=NS) and overall fetal loss (3.8% vs. 6.8%; P=NS) rates.
Compared with the control group, ER in twins had a higher miscarriage and fetal loss rate, whereas FR in twins was similar to the control group. So, the FR procedure is overall a better and safer approach of MPR in reducing morbidity and mortality in HOMPs.
KeywordsHigh-order multiple pregnancies Multifetal pregnancy reduction Twin pregnancy Miscarriage rate Preterm delivery
MSK: Manuscript writing, SK: Protocol/project development, data management, EDN: Manuscript writing/editing, JI: Data collection, EA: Data analysis, JES: Data collection, MJM: Protocol/project development.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Garg P, Abdel-Latif ME, Bolisetty S, Bajuk B, Vincent T, Lui K (2010) Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW and the ACT, Australia (1994–2005). Arch Dis Child Fetal Neonatal Ed 95(1):F20–24. https://doi.org/10.1136/adc.2009.157701 CrossRefPubMedGoogle Scholar
- 3.Qin JB, Sheng XQ, Wang H, Chen GC, Yang J, Yu H, Yang TB (2017) Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies. Arch Gynecol Obstet 295(3):577–597. https://doi.org/10.1007/s00404-017-4291-2 CrossRefPubMedGoogle Scholar
- 8.Chung K, Coutifaris C, Chalian R, Lin K, Ratcliffe SJ, Castelbaum AJ, Freedman MF, Barnhart KT (2006) Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization. Fertil Steril 86(6):1634–1641. https://doi.org/10.1016/j.fertnstert.2006.04.038 CrossRefPubMedGoogle Scholar
- 10.Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G (2013) ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 41(1):102–113. https://doi.org/10.1002/uog.12342 CrossRefGoogle Scholar
- 11.Evans MI, Berkowitz RL, Wapner RJ, Carpenter RJ, Goldberg JD, Ayoub MA, Horenstein J, Dommergues M, Brambati B, Nicolaides KH, Holzgreve W, Timor-Tritsch IE (2001) Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol 184(2):97–103. https://doi.org/10.1067/mob.2001.108074 CrossRefPubMedGoogle Scholar
- 12.Stone J, Ferrara L, Kamrath J, Getrajdman J, Berkowitz R, Moshier E, Eddleman K (2008) Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR). Am J Obstet Gynecol 199 (4):406 e401–404. https://doi.org/10.1016/j.ajog.2008.06.017
- 15.Timor-Tritsch IE, Bashiri A, Monteagudo A, Rebarber A, Arslan AA (2004) Two hundred ninety consecutive cases of multifetal pregnancy reduction: comparison of the transabdominal versus the transvaginal approach. Am J Obstet Gynecol 191(6):2085–2089. https://doi.org/10.1016/j.ajog.2004.05.024 CrossRefPubMedGoogle Scholar
- 19.Bhandari S, Ganguly I, Agrawal P, Bhandari S, Singh A, Gupta N (2016) Comparative analysis of perinatal outcome of spontaneous pregnancy reduction and multifetal pregnancy reduction in triplet pregnancies conceived after assisted reproductive technique. J Hum Reprod Sci 9(3):173–178. https://doi.org/10.4103/0974-1208.192058 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Stone J, Belogolovkin V, Matho A, Berkowitz RL, Moshier E, Eddleman K (2007) Evolving trends in 2000 cases of multifetal pregnancy reduction: a single-center experience. Am J Obstet Gynecol 197 (4):394 e391–394. https://doi.org/10.1016/j.ajog.2007.06.056